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Primum Non Tacere: An Ethics of Speaking Up

Creator

Dwyer, James

Bibliographic Citation

Hastings Center Report. 1994 Jan-Feb; 24(1): 13-18.

Abstract

There are many reasons why [medical] students find it difficult to speak up. Some do not think it is their place or job to do so. Some are concerned about possible adverse effects on their grades, particularly when doing clerkships in specialties they hope to enter. Some fear that they will be subjected to ridicule for asking a question or expressing a concern. Some learn that it is considered improper to criticize fellow physicians. Some want to be viewed as loyal to the team, and few want to be seen as a rat or tattletale. In spite of the reasons that make it difficult for students to speak up, I have argued that they have an obligation to do so. But by focusing on students' obligations I did not mean to excuse the people above them. Speaking up is a problem for everyone in medicine, and those with more power and authority have a greater obligation to confront the problem. They have a responsibility to speak up and a responsibility to try to change the conditions that make it so difficult for those below them to speak up....I guess I am really suggesting that the practice of medicine needs to become more Socratic. Perhaps medicine could not function if everyone acted like Socrates -- perhaps there would be too much discussion and too little patient care. Yet I believe that medicine could function quite well if everyone were a little more Socratic, a little more willing to raise questions about what is right and good.